Billing and Coding: Chemotherapy Administration - R25

This coverage article has been revised and published for notice under contract numbers: 02101 (AK), 02201 (ID), 02301(OR), 02401 (WA), 03101 (AZ), 03201 (MT), 03301 (ND), 03401 (SD), 03501 (UT), and 03601 (WY).

Effective Date of Article: October 19, 2020
Summary of Article Changes: The following updates were made to remove outdated coding information from July and October 2019 in the Group 3 Paragraph table. Added  the new and revised HCPCS codes payable in the Outpatient Prospective Payment System (OPPS) and Ambulatory Surgery Center (ASC) setting to the Group 3 and 4 Paragraph tables effective on 10/01/2020 and are listed below.

  1. Revised:
    1.  J9305 from Pemetrexed, 10 mg to Pemetrexed, not otherwise classified, 10 mg.
  2. Added:
    1. C9062 for daratumumab and hyaluronidase-fihj (Darzalex FasPro),
    2. C9064 for Mitomycin pyelocalyceal (Jelmyto™) instillation, 1mg,
    3. C9065 for romidepsin, non-lypoilized (romidepsin) (e.g. liquid), 1mg,
    4. C9066 for sacituzumab govitecan-hziy (Trodelvey™), 180 mg all in the OPPS setting, and
    5. J9227 for isatuximab-irfc (Sarclisa®), 10mg.

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            Last Updated Fri, 25 Sep 2020 18:51:41 +0000